2005 CFR Title 20, Volume 1

Title 20--Employees' Benefits CHAPTER I--OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR PART 10--CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED
	10.0	What are the provisions of the FECA, in general?
	10.1	What rules govern the administration of the FECA and this chapter?
	10.2	What do these regulations contain?
	10.3	Have the collection of information requirements of this part been approved by the Office of Management and Budget (OMB)?
	10.5	What definitions apply to these regulations?
	10.6	What special statutory definitions apply to dependents and survivors?
	10.7	What forms are needed to process claims under the FECA?
	10.10	Are all documents relating to claims filed under the FECA considered confidential?
	10.11	Who maintains custody and control of FECA records?
	10.12	How may a FECA claimant or beneficiary obtain copies of protected records?
	10.13	What process is used by a person who wants to correct FECA-related documents?
	10.15	May compensation rights be waived?
	10.16	What criminal penalties may be imposed in connection with a claim under the FECA?
	10.17	Is a beneficiary who defrauds the Government in connection with a claim for benefits still entitled to those benefits?
	10.18	Can a beneficiary who is incarcerated based on a felony conviction still receive benefits?
	10.100	How and when is a notice of traumatic injury filed?
	10.101	How and when is a notice of occupational disease filed?
	10.102	How and when is a claim for wage loss compensation filed?
	10.103	How and when is a claim for permanent impairment filed?
	10.104	How and when is a claim for recurrence filed?
	10.105	How and when is a notice of death and claim for benefits filed?
	10.110	What should the employer do when an employee files a notice of traumatic injury or occupational disease?
	10.111	What should the employer do when an employee files an initial claim for compensation due to disability or permanent impairment?
	10.112	What should the employer do when an employee files a claim for continuing compensation due to disability?
	10.113	What should the employer do when an employee dies from a work-related injury or disease?
	10.115	What evidence is needed to establish a claim?
	10.116	What additional evidence is needed in cases based on occupational disease?
	10.117	What happens if, in any claim, the employer contests any of the facts as stated by the claimant?
	10.118	Does the employer participate in the claims process in any other way?
	10.119	What action will OWCP take with respect to information submitted by the employer?
	10.120	May a claimant submit additional evidence?
	10.121	What happens if OWCP needs more evidence from the claimant?
	10.125	How does OWCP determine entitlement to benefits?
	10.126	What does the decision contain?
	10.127	To whom is the decision sent?
	10.200	What is continuation of pay?
	10.205	What conditions must be met to receive COP?
	10.206	May an employee who uses leave after an injury later decide to use COP instead?
	10.207	May an employee who returns to work, then stops work again due to the effects of the injury, receive COP?
	10.210	What are the employee's responsibilities in COP cases?
	10.211	What are the employer's responsibilities in COP cases?
	10.215	How does OWCP compute the number of days of COP used?
	10.216	How is the pay rate for COP calculated?
	10.217	Is COP charged if the employee continues to work, but in a different job that pays less?
	10.220	When is an employer not required to pay COP?
	10.221	How is a claim for COP controverted?
	10.222	When may an employer terminate COP which has already begun?
	10.223	Are there other circumstances under which OWCP will not authorize payment of COP?
	10.224	What happens if OWCP finds that the employee is not entitled to COP after it has been paid?
	10.300	What are the basic rules for authorizing emergency medical care?
	10.301	May the physician designated on Form CA-16 refer the employee to another medical specialist or medical facility?
	10.302	Should the employer authorize medical care if he or she doubts that the injury occurred, or that it is work-related?
	10.303	Should the employer use a Form CA-16 to authorize medical testing when an employee is exposed to a workplace hazard just once?
	10.304	Are there any exceptions to these procedures for obtaining medical care?
	10.310	What are the basic rules for obtaining medical care?
	10.311	What are the special rules for the services of chiropractors?
	10.312	What are the special rules for the services of clinical psychologists?
	10.313	Will OWCP pay for preventive treatment?
	10.314	Will OWCP pay for the services of an attendant?
	10.315	Will OWCP pay for transportation to obtain medical treatment?
	10.316	After selecting a treating physician, may an employee choose to be treated by another physician instead?
	10.320	Can OWCP require an employee to be examined by another physician?
	10.321	What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee?
	10.322	Who pays for second opinion and referee examinations?
	10.323	What are the penalties for failing to report for or obstructing a second opinion or referee examination?
	10.324	May an employer require an employee to undergo a physical examination in connection with a work-related injury?
	10.330	What are the requirements for medical reports?
	10.331	How and when should the medical report be submitted?
	10.332	What additional medical information will OWCP require to support continuing payment of benefits?
	10.333	What additional medical information will OWCP require to support a claim for a schedule award?
	10.335	How are medical bills submitted?
	10.336	What are the time frames for submitting bills?
	10.337	If OWCP reimburses an employee only partially for a medical expense, must the provider refund the balance of the amount paid to the employee?
	10.400	What is total disability?
	10.401	When and how is compensation for total disability paid?
	10.402	What is partial disability?
	10.403	When and how is compensation for partial disability paid?
	10.404	When and how is compensation for a schedule impairment paid?
	10.405	Who is considered a dependent in a claim based on disability or impairment?
	10.406	What are the maximum and minimum rates of compensation in disability cases?
	10.410	Who is entitled to compensation in case of death, and what are the rates of compensation payable in death cases?
	10.411	What are the maximum and minimum rates of compensation in death cases?
	10.412	Will OWCP pay the costs of burial and transportation of the remains?
	10.413	If a person dies while receiving a schedule award, to whom is the balance of the schedule award payable?
	10.414	What reports of dependents are needed in death cases?
	10.415	What must a beneficiary do if the number of beneficiaries decreases?
	10.416	How does a change in the number of beneficiaries affect the amount of compensation paid to the other beneficiaries?
	10.417	What reports are needed when compensation payments continue for children over age 18?
	10.420	How are cost-of-living adjustments applied?
	10.421	May a beneficiary receive other kinds of payments from the Federal Government concurrently with compensation?
	10.422	May compensation payments be issued in a lump sum?
	10.423	May compensation payments be assigned to, or attached by, creditors?
	10.424	May someone other than the beneficiary be designated to receive compensation payments?
	10.425	May compensation be claimed for periods of restorable leave?
	10.430	How does OWCP notify an individual of a payment made?
	10.431	What does OWCP do when an overpayment is identified?
	10.432	How can an individual present evidence to OWCP in response to a preliminary notice of an overpayment?
	10.433	Under what circumstances can OWCP waive recovery of an overpayment?
	10.434	If OWCP finds that the recipient of an overpayment was not at fault, what criteria are used to decide whether to waive recovery of it?
	10.435	Is an individual responsible for an overpayment that resulted from an error made by OWCP or another Government agency?
	10.436	Under what circumstances would recovery of an overpayment defeat the purpose of the FECA?
	10.437	Under what circumstances would recovery of an overpayment be against equity and good conscience?
	10.438	Can OWCP require the individual who received the overpayment to submit additional financial information?
	10.439	What is addressed at a pre-recoupment hearing?
	10.440	How does OWCP communicate its final decision concerning recovery of an overpayment, and what appeal right accompanies it?
	10.441	How are overpayments collected?
	10.500	What are the basic rules governing continuing receipt of compensation benefits and return to work?
	10.501	What medical evidence is necessary to support continuing receipt of compensation benefits?
	10.502	How does OWCP evaluate evidence in support of continuing receipt of compensation benefits?
	10.503	Under what circumstances may OWCP reduce or terminate compensation benefits?
	10.505	What actions must the employer take?
	10.506	May the employer monitor the employee's medical care?
	10.507	How should the employer make an offer of suitable work?
	10.508	May relocation expenses be paid for an employee who would need to move to accept an offer of reemployment?
	10.509	If an employee's light-duty job is eliminated due to downsizing, what is the effect on compensation?
	10.515	What actions must the employee take with respect to returning to work?
	10.516	How will an employee know if OWCP considers a job to be suitable?
	10.517	What are the penalties for refusing to accept a suitable job offer?
	10.518	Does OWCP provide services to help employees return to work?
	10.519	What action will OWCP take if an employee refuses to undergo vocational rehabilitation?
	10.520	How does OWCP determine compensation after an employee completes a vocational rehabilitation program?
	10.525	What information must the employee report?
	10.526	Must the employee report volunteer activities?
	10.527	Does OWCP verify reports of earnings?
	10.528	What action will OWCP take if the employee fails to file a report of activity indicating an ability to work?
	10.529	What action will OWCP take if the employee files an incomplete report?
	10.535	How are dependents defined, and what information must the employee report?
	10.536	What is the penalty for failing to submit a report of dependents?
	10.537	What reports are needed when compensation payments continue for children over age 18?
	10.540	When and how is compensation reduced or terminated?
	10.541	What action will OWCP take after issuing written notice of its intention to reduce or terminate compensation?
	10.600	How can final decisions of OWCP be reviewed?
	10.605	What is reconsideration?
	10.606	How does a claimant request reconsideration?
	10.607	What is the time limit for requesting reconsideration?
	10.608	How does OWCP decide whether to grant or deny the request for reconsideration?
	10.609	How does OWCP decide whether new evidence requires modification of the prior decision?
	10.610	What is a review by the Director?
	10.615	What is a hearing?
	10.616	How does a claimant obtain a hearing?
	10.617	How is an oral hearing conducted?
	10.618	How is a review of the written record conducted?
	10.619	May subpoenas be issued for witnesses and documents?
	10.620	Who pays the costs associated with subpoenas?
	10.621	What is the employer's role when an oral hearing has been requested?
	10.622	May a claimant withdraw a request for or postpone a hearing?
	10.625	What kinds of decisions may be appealed?
	10.626	Who has jurisdiction of cases on appeal to the ECAB?
	10.700	May a claimant designate a representative?
	10.701	Who may serve as a representative?
	10.702	How are fees for services paid?
	10.703	How are fee applications approved?
	10.705	When must an employee or other FECA beneficiary take action against a third party?
	10.706	How will a beneficiary know if OWCP or SOL has determined that action against a third party is required?
	10.707	What must a FECA beneficiary who is required to take action against a third party do to satisfy the requirement that the claim be ``prosecuted''?
	10.708	Can a FECA beneficiary who refuses to comply with a request to assign a claim to the United States or to prosecute the claim in his or her own name be penalized?
	10.709	What happens if a beneficiary directed by OWCP or SOL to take action against a third party does not believe that a claim can be successfully prosecuted at a reasonable cost?
	10.710	Under what circumstances must a recovery of money or other property in connection with an injury or death for which benefits are payable under the FECA be reported to OWCP or SOL?
	10.711	How much of any settlement or judgment must be paid to the United States?
	10.712	What amounts are included in the gross recovery?
	10.713	How is a structured settlement (that is, a settlement providing for receipt of funds over a specified period of time) treated for purposes of reporting the gross recovery?
	10.714	What amounts are included in the refundable disbursements?
	10.715	Is a beneficiary required to pay interest on the amount of the refund due to the United States?
	10.716	If the required refund is not paid within 30 days of the request for repayment, can it be collected from payments due under the FECA?
	10.717	Is a settlement or judgment received as a result of allegations of medical malpractice in treating an injury covered by the FECA a gross recovery that must be reported to OWCP or SOL?
	10.718	Are payments to a beneficiary as a result of an insurance policy which the beneficiary has purchased a gross recovery that must be reported to OWCP or SOL?
	10.719	If a settlement or judgment is received for more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim be attributed to different conditions for purposes of calculating the refund or credit owed to the United States?
	10.725	When is a Federal grand or petit juror covered under the FECA?
	10.726	When does a juror's entitlement to disability compensation begin?
	10.727	What is the pay rate of jurors for compensation purposes?
	10.730	What are the conditions of coverage for Peace Corps volunteers and volunteer leaders injured while serving outside the United States?
	10.731	What is the pay rate of Peace Corps volunteers and volunteer leaders for compensation purposes?
	10.735	When is a non-Federal law enforcement officer (LEO) covered under the FECA?
	10.736	What are the time limits for filing a LEO claim?
	10.737	How is a LEO claim filed, and who can file a LEO claim?
	10.738	Under what circumstances are benefits payable in LEO claims?
	10.739	What kind of objective evidence of a potential Federal crime must exist for coverage to be extended?
	10.740	In what situations will OWCP automatically presume that a law enforcement officer is covered by the FECA?
	10.741	How are benefits calculated in LEO claims?
	10.800	What kind of medical records must providers keep?
	10.801	How are medical bills to be submitted?
	10.802	How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses?
	10.803	What are the time limitations on OWCP's payment of bills?
	10.805	What services are covered by the OWCP fee schedule?
	10.806	How are the maximum fees defined?
	10.807	How are payments for particular services calculated?
	10.808	Does the fee schedule apply to every kind of procedure?
	10.809	How are payments for medicinal drugs determined?
	10.810	How are payments for inpatient medical services determined?
	10.811	When and how are fees reduced?
	10.812	If OWCP reduces a fee, may a provider request reconsideration of the reduction?
	10.813	If OWCP reduces a fee, may a provider bill the claimant for the balance?
	10.815	What are the grounds for excluding a provider from payment under the FECA?
	10.816	What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies?
	10.817	When are OWCP's exclusion procedures initiated?
	10.818	How is a provider notified of OWCP's intent to exclude him or her?
	10.819	What requirements must the provider's reply and OWCP's decision meet?
	10.820	How can an excluded provider request a hearing?
	10.821	How are hearings assigned and scheduled?
	10.822	How are subpoenas or advisory opinions obtained?
	10.823	How will the administrative law judge conduct the hearing and issue the recommended decision?
	10.824	How can a party request review by the Director of the administrative law judge's recommended decision?
	10.825	What are the effects of exclusion?
	10.826	How can an excluded provider be reinstated?